围术期外周血相关指标预测结肠癌根治术患者预后的临床意义

Significance of peripheral blood analysis during perioperation for the prognosis of patients with colon cancer radical mastectomy

目的探讨围术期外周血指标中性粒细胞与淋巴细胞的比值(NLR)、间接中性粒细胞与淋巴细胞的比值(D-NLR)、血小板与淋巴细胞的比值(PLR)、淋巴细胞与单核细胞的比值(LMR)预测结肠癌根治术患者预后的临床意义。方法随机选择2010年10月至2014年10月于普通外科行根治性手术的结肠癌患者156例,回顾性分析其临床资料,按术后3年内随访结果将156例患者分为复发组92例和无复发组64例。比较两组患者的临床资料和外周血指标,采用特征曲线(ROC曲线)分析外周血参数的特异性和敏感性,建立Logistic回归模型评估其对于预后的检测性能,应用Youden指数计算最佳界限值。结果两组患者在术后淋巴细胞计数、术前NLR、D-NLR、LMR及术后PLR比较,差异均有统计学意义(P<0.05)。ROC曲线:术前NLR、D-NLR以及术后D-NLR、PLR的AUC较高。Youden指数所示诊断界限值:术前NLR>3.19、D-NLR<1.91和术后D-NLR<3.17、PLR>174.4可能是预后的诊断参考标准之一。以影响因素为自变量进行Logistic回归方程为分析,预测准确率为96.2%。结论结肠癌患者免疫状态的差异可引起机体中性粒细胞和淋巴细胞计数的变化,结肠癌根治术前NLR、术后PLR、术前及术后的D-NLR指标可能是预测结肠癌复发的外周血参数。

Objective To investigate the significance of neutrophil-to-lymphocyte ratio （NLR）, derived neutrophiho-lymphocyte ratio （D-NLR）, platelet-to-lymphocyte ratio （PLR） and lymphocyte-to- monocyte ratio （LMR） on the prognosis of patients with colon cancer radical mastectomy. Methods The clinical data of 156 patients with colon cancer in the department of general surgery from October 2010 to October 2014 were analyzed retrospectively. According to the follow-up results within 3 years after the op- eration, 156 patients were divided into the recurrent group （92 cases） and the non-relapse group （64 cases）. The clinical data and peripheral blood indexes of the two groups were compared and the specificity and sensitivity of the peripheral blood parameters were analyzed by the characteristic curve （ROC curve）. The Logistic regression model was established to evaluate the detection performance of the pe- ripheral blood, and the best boundary value was calculated by using the Youden index. Results There were significant differences in the lymphocyte count, preoperative NLR, D-NLR, LMR and the postoper- ative PLR between the two groups （P 〈 0. 05 ）. The ROC curve showed that the preoperative NLR, D-NLR and the postoperative AUC of D-NLR and PLR were higher. The diagnostic threshold value of Youden index showed that the NLR 〉 3.19, the D-NLR 〈 1.91 before the operation and the D-NLR 〈 3.17, the PLR 〉 174. 4 after the operation, may be one of the diagnostic criteria for prognosis. Taking the influencing factors as independent variables, the Logistic regression equation was used for analysis, and the prediction accuracy rate was 96. 2%. Conclusions The difference in immune state of patients with colon cancer may cause the changes of neutrophils and lymphocyte counts. The D-NLR index before radical resection of colon cancer, postoperative PLR, preoperative and postoperative D-NLR may be the peripheral blood parameters to predict the recurrence of colon cancer.